sábado, 11 de março de 2017

A blank page and so much to say. Yet, words feel so little when the feeling is so big. How can I thank you enough, honour you enough, make any justice to what you really are and how much you've represented to me?

Mua, you've honestly been one of the best things I've had in my life. I arrived in a sunny afternoon, full of hopes, projects and ideas. And since that very first day, you've never failed to impress me. You've surpassed all my expectations and brought me so much happiness and life lessons.

In Mua I've learned the true meaning of kindness and sharing. I've learned to share what I have and that it's only fair if we all have the same. But even if we don't, and even if you are aware of that, you'll never fail on being the most honest and kind people ever. In Mua I've learned that life isn't fair, that circumstances take little people away from us and that your days will suck everytime that happens. But I've also learned to cherish life, to fight for those who are still fighting themselves and to not take anything for granted. I've learned that nothing hurts more than telling a mom she won't take her little person home - and there's absolutely nothing you can do to ease that pain. I've learned to help everytime I could and to back off everytime I couldn’t - for as much as it hurts. I've learned that happiness doesn’t have anything to do with the money in your pockets or the size of your house. It has much more to do with simplifying things and valuing everything you have.

I learned that I am very lucky, we all are. Our taps open to let clear water run. Our houses have electricity 24h a day. We all have a kitchen, an oven, a stove. We all have (easy access) food to get busy in the kitchen with. If we get really sick, there will be a hospital within a reasonable distance and amazingly equipped to treat us.

I think about it and all my thoughts get tangled. There is so much I miss, I can't even phrase it in a logical and understandable order. I miss the smiles, the giggles, the endless laughter. I miss waking up and starting the fire to prepare my coffee. I miss the birds, the silence, the peace of those mornings. I miss getting out of the house and not being able to walk 200m without greeting at least 10 persons. I miss the walks to the market, the lady in the little shop and all the kids running around me. I miss Christopher and the woodcarvers, with all the questions and the cultural lessons. I miss Sobo, nsima, eating with my hands. The big market and all the vibes that it brings. I miss the hospital, the morning meetings, the endless discussions over patient's cases, the chats with all the awesome nurses, the joy for seeing the kids getting better.

Since the first day, I missed you. I knew I would. And that’s why I've lived everyday there as if it was my last. Because I knew my last day would come. And I knew it would be hard. "But no one ever said it would be so hard".

Thank you so much. Zikomo Kwambiri. And please take care, will you Mua? I really hope you do well. You and all the people within you, the kids, the nurses, the doctors, the woodcarvers, the people at the village. I hope you'll keep the magic inside you. And that the stars will always shine the right path for everyone who helped me being happy in mine.

EN January arrived and with it came the rain, the smell of wet soil and the mud that sticks to my shoes and that I carry everywhere. January brought the green fields and the maze that fibally grows - for in a few months be transformed in flour and then cooked in 'nsima' (traditional malawian dish, ingested daily). January brought the rivers full of water and the electricity generated from it. The baby-frogs that jump everywhere in my house and the fireflies that know invade the fields of stars everytime the night comes.

The thing is, January also brought us the mosquitoes. Those annoying bugs that love the rain and whose favourite hobbie is to fill your legs and arms with tiny little itchy bites - and in some unfortunate occasions, they are the ones transmitting us the god-damn malaria. January brought the growing maize, which is still not ready to be eaten. The maize from last year is starting now to get to an end and the last bags are sold at excruciating prices. January brought the floods and the destruction of entire villages that created now a bunch of homeless families. With January came the hunger, malaria and poverty.

I don't really like the rain. It's just rain, I know that. But it brings so much with it. My grandma used to say "the rain is good Cristina. It means we don't need to water the fields". And my grandma was right. Everyone at the village says the same. The only problem is being able to face this period, even when you know that "the rainbow" will come after it.

I came back to the Paediatric Ward. The beds that I was used to see empty are now all full. In some days, there is no more place for new patients. Malaria. Severe Malaria. Cerebral Malaria. Meningitis. Pneumonia. Severe Pneumonia. Asthmatic Attack. Gastroenteritis. Severe dehydration. Severe Malnutrition. Malaria, malaria, malaria. It's always the little ones who suffer with all this.

The kids get to the hospital, which one sicker than the previous one. Seizures, coma, hypoglycaemia, severe dehydration, anaemia. Hypovolaemic shock, septic shock, sepsis. The hands of the nurses multiply between those who need medication to stop convulsing, and others who need blood transfusions and oxygen ASAP. Today there are no blood units. Or IV fluids. Or the really nice medication to treat malaria. Gloves. Strips to check the blood glucose. Antibiotics. IV Dextrose. Strips to check the haemoglobin levels. And the new patients that won't stop coming.

We try to find solutions here and there. Running from one ward to the other. I need this, this and that. "My patient is having seizures". I take my cooler box to the lab, so I can later come back with 2, 3, 4 units of blood that I transfuse to my little patients. And they scream because they are afraid. Of the blood, the cannula in their tiny arms, the disease that invaded their bodies. I don't blame them, because I'm afraid to. I'm afraid for them, for their mom or grandma that will remain next to their bed day and night, calming them down. I'm afraid because I know that not all this mothers will come back home with their kids in the arms.

But I want all of them to survive. We all do. Never in Paediatrics you will see a nurse giving up. Because that's not an option and everyone knows it - and those little warriors know it all too well. With only a few months, years of life, they already fight fiercely against diseases that are more severe than the ones most of us ever had to face. You should see them wining the daily battles, sucking up the tears and fixing the eyes of their moms with all the hope left in them. Believe me when I say: these kids are stronger than so many people in this world.

It's the end of my shift. Writing "Death: 0" on the day report is a little victory. A little step. I come back home and play with the kids that live in the neighbourhood. They are so full of life, joy and laughter. They are the ones getting a smile out of me on my most desperate days. At night I look at the stars and think about my little boys and little girls. I'm very proud of my little warriors. You did well. You were so brave and strong. I don't think you lost the battle - it was an unfair one, anyway. You were fierce little warriors and fought until the last second. And I fought next to your bed, with my heart so tight. I did my best, I promise. I'm sorry that your story came to an end when you were atill writing your first pages. I will forever remember each one of you, at every shining star, at every firefly that crosses my way. I promise.

One of the things I admire the most in my patients here, in Malawi, is the incredible tolerance they have to pain and how fast they can recover from severe conditions.

But this patient is not like that. Not only she isn’t getting better, she has actually been getting worse as the days go by. Semiconscious, she is always surrounded by her family, who look at each other in silence, pray and scare the flies away – the ones that keep bothering her, like she didn’t have enough problems already. HIV positive, she was admitted 2 weeks ago: malaria. After the typical treatment –which works brilliantly and has been saving so many lives – she was discharged and went home, despite still being anaemic from the famous falciparum parasites. 3 days ago she came back. Too weak, she arrived to the hospital in hypothermia, hypoglycaemia, severe anaemia, an ugly cough.

Some people say HIV/AIDS doesn’t kill. Yes, that’s true. HIV/AIDS alone doesn’t kill – never a medical report has been written with HIV/AIDS as cause of death. What kills is the immunosuppression that these patients, sooner or later, end up facing. And after that, any infection can kill: a cold, an episode of malaria, pneumonia. Pneumonia usually doesn’t kill, especially if you are a young woman of 34 years old. Except if you have HIV/AIDS.

In this patient’s file, the same plan was being written as a priority every single day: blood transfusion. At the hospital’s blood bank, there is lack of units for some blood groups; my patient’s is one of them. There is no O positive. The explanation is given to the family: either we find a compatible donor, or they’ll have to travel 1h up the hill to reach the District Hospital where (maybe) the blood she needs will be available. Soon after that, a small battalion of people from her family comes with me to the lab so they can be tested. None of them is compatible. You can feel the desolation in their faces.

In the middle of all chaos, me and the nurse realise that the lab form stating that the patient is O positive is missing, nowhere to be found. We have no other solution than collecting another sample. I come back to the Lab. “Well, it seems that this patient is not O+… She is A-“. A negative. “Does that mean we have her type of blood in the blood bank?” No. “Or that one of the family members is compatible?” No.

A negative. I come back to the ward whilst still trying to remember what my blood type is. I explained to the other nurse what’s happening, but there’s still no blood available. The doctor hears us talking and says “Ah that type of blood is very difficult to find here. Even at the Central Blood Bank they have none available”. It’s lunch time, I go home quickly with an idea in my mind – after searching thoroughly in my bag, I finally find my health passport. Where I’ve kept my little blue card – where my blood type is written down. A negative.

I quickly go back to the hospital and explain my plan to the nurse, that I have the same blood type as the patient and want to donate my blood. Me, who hates needles – yes I know it’s a paradox -> the nurse who doesn’t like needs. But when you donate blood it’s not even a needle we’re talking about – it’s a small bazooka that they insert through our skin (and here in Malawi they take this seriously, I’ve never seen such a big needle). But that’s the smallest problem of all. For me, who sees this patient every day, lying in a hospital bed.

I wait for the Lab to open after lunch time. Under the rain, I walk with my cooler box, the one that goes empty but shall return with a unit of my own blood. The lab technician looks at me quite surprised “You want to donate your blood?” – Even he was trying to figure out a way of finding blood for this patient. And that’s when all the questions, blood samples and tests started to make sure I had the right type of blood and that I was in good health. After that, a tourniquet. Cotton with alcohol. A needle. An empty bag. 5 minutes. A full bag. “I think I saw you yesterday, playing with a ball… with the kids?” Yes, that was me. “Today and tomorrow, there’s no games for you. No running with the kids.” After all the advice and some forced rest, I came back to the ward. Me and my cooler box, a unit of A negative blood inside.

I started the blood transfusion to my patient. The family knows it’s my own blood and they are out of words; they soon start thanking me and saying “God, bless you”, all in Chichewa. The patient sleeps, exhausted. The blood runs. It’s the end of my shift. I hope I’ll find this patient tomorrow again and that there will still be time to do something for her.

When we study to become nurses, there is one expression that we will hear a dozen times a year “you will save lives”. Being a nurse often means that you’ll be saving someone else’s life. Sometimes we don’t even realize it. Our actions trough a shift will eventually get our patients better and they’ll be discharged, go home, free of danger. Sometimes, in emergency situations, doctors and nurses come together to save the life they have in their hands. What nobody ever tells us, and which we are never really prepared for, is: you won’t save all the lives. And at the beginning that hurts. You learn to live with that, to let your work at work and you keep going with your life. Except when someone goes too soon, when you meet someone who was still “OK” before everything went wrong. You will have patients who will be really special to you - on those days, you won’t be able to “undress” your uniform and go home in peace. On those days you’ll open your door, speak with your family and friends, have dinner, watch a movie, sleep – always with that patient in your mind; like a chewing gum that got stuck in your shoe and follows you everywhere.

The truth is: even if I strongly want to believe it, I’m not sure if this patient is going to survive. Her condition is so fragile. And that hurts. But even in those days where we don’t save lives, we still try. Always. And that’s how we fall asleep in peace at the end of the day, because we’ve done everything that was possible. And in some special days, we’ve done the impossible too.

sábado, 31 de dezembro de 2016

This is the saddest entry I’ve ever written in this blog. Please don’t read it if you’re too sensitive or easily impressionable. I mean it, just don’t. Because if I was given a choice, I would have preferred to “unsee” what happened that day. But I wasn’t. So here is the story of Little Boy.

They say 2016 wasn’t good for us: too many bad things happened; too many bright people were taken away from us. And I feel very sorry for them and their families, I truly do. But if the World only knew Little Boy – then everyone would understand the true meaning of sorrow. Of all the stars gone this year, Little Boy was the brightest. I’ve given a lot of thought to whereas I should write this or not, but I feel that the World should know your story, so here it goes.

That day I was finally back to Mua, my little paradise. Mua feels like home now and it was so heart-warming to feel welcomed by everyone. I was happy to be back. Tired and hungry, I decided to go to the market so I could buy some food and I could cook myself a nice dinner. Little did I know that, that day, this wasn’t a simple stroll to the market.

When I was trying to talk with the lady from the little shop – mixing English and Chichewa, in the hopes of getting all the ingredients I wanted, something happened. Everyone started shouting and running towards the river, 2-3 minutes away. Without understanding any of their words, I followed them. In the way, I found a lady standing in the porch of her house and asked what was going on. “It seems that a child was playing in the river and drowned. They are trying to find him.”

So I rushed down the hill to see the saddest episode I’ve ever seen in my life. Around the little pod that the river forms down the valley, there was a crowd reunited. Circling the pod, everyone waited with expectation and fear for what was going to happen next. I kept walking down the little hill so I could understand what’s going on.

Three men were diving in the waters which are so much deeper than I ever thought, hoping to find Little Boy. The silence was heart-breaking. And finally we saw him. In the body of a 5 year’s old little child, life had abandoned him down that river, a few hours ago already. But I didn’t know that. So I ran to him, hoping that I could do something to save him. But I couldn’t. That tiny little body was immediately covered with pieces of fabric and the sound of crying and screaming that immediately filled the air was deafening. My heart was beating fast enough for both of us – if only that was a possibility. If only I could give you a little bit of my life so you could come back again. But I couldn’t. I will never forget the faces of everyone around me. The little girl sobbing on the floor. She was too little to know what the death of a loved-one feels like, but there she was: after watching everything that just happened – she probably waited all those hours without knowing where Little Boy was. Little did she know that he wasn’t here anymore.

I am so sorry, Little Boy. I am sorry that all the circumstances led to this and that 2016 took you – it was definitely too early for you. I am sorry that you were born in a country where running water is not a thing – but bathing in the river is. That you probably belonged to a family of several siblings and you would usually play all together – even if it was in that deep river and none of you knew how to swim. I am sorry that your parents were not around – they were probably working to try and provide you the best life they could possibly afford. I’m sorry I wasn’t there for you little boy – I wish I was, I wish I could have saved you – but I couldn’t.

You didn’t get a chance to wear your new uniform on the first day of school. To play with the other kids between classes – you didn’t get a chance to find out that this is the best thing about school. You didn’t get a chance to leave Mua and find all the wonders of Malawi – the lake, the elephants, the zebras, the hippos. To have your first girlfriend, your first love, your first kiss. You were not given a chance in life Little Boy, and I am so sorry.

That night, I went to sleep hearing the sound of the drums within a distance – at the village, your family cries for you. I am sorry that the World doesn’t know you like they knew George Michael or Princess Lea. When I was asked if I knew you I firstly said no. But I actually do. You were the little boy shouting “Hello! Hello!” every time I went to the market. You were the little boy running in front of me and laughing every time I reached that little street of shops. I’m sorry I didn’t get a chance to know you better. I’m sorry that the World doesn’t know you, you don’t know the World. We failed to introduce you to each other, wasn’t it?

I want you to know that I will forever hold you in a very special place of my heart. The World might not know about your story, but I do. I have shed enough tears to cover for all the people around the World, believe me. I will also smile and play with many, many kids – in your honour. Because I’m sure that’s what you wanted – a life full of happiness and joy. Tonight the sky cried for you. And after all those tears were gone, the most beautiful sky of stars appeared – I’m pretty sure there is a new star tonight. The brightest of all.

EN I'm writing this while I travel in a mini-bus (little van, where the maximum load should be 15 but that never leaves before being overloaded with at least 20 adults - not counting the children that sit on the lap so they don't pay, the chickens that travel with their feet tied up and an occasional goat that cries for mercy the whole trip, stuck underneath the seats). Under a striking heat and a resplendent sun, I can varely believe it's already Christmas.

Forget the endless advertisements on TV with gazillions of toys that stick into kids minds. Christmas decorations that the supermarket set up 2 months earlier. The little fortune that every city spends on street illumination, giant trees and animated nativity sets. Here there's no place for any of that.

But it's Christmas. Mothers go to the market early in the morning to assure they find the best ingredients for Christmas' dinner. Today they spend a bit more than usual, which represents a little hole in the family finances (but it's OK, it's Christmas after all) - and come back home with big bags or baskets that they balance in their heads. Families, frequently spread across different villages, travel so they can all meet up. Which includes loooong trips in the overloaded little buses.

I know it's Christmas because I've never seen shirts so white, chitenjes (african fabric that women tie around their waists) so pretty and shoes so new in the children's feet. For most of the people here, there is no money for gifts. But the happiness upon receiving a car made of cans pulled by a piece of rope is almost the same as the one felt by the kids who receive the last collection of overpriced video games that they pile up with all the others.

It's Christmas because everyone walks around with a smile on tgeir faces, shiny eyes and rhe happiness that only Christmas brings. Just like that, pure and simple. Not better nor worse, just different. And in the end, I'm quite happy to be a part of it.

EN When people ask me "Why Africa?", "What makes you leave like that", "Aren't you afraid?". I can never give a good answer. I try to say this and that, give one or two examples, take some of the best days of my life and explain them in words. But it lacks all the magic that these experiences have.

Explaining in a few words the pure happiness that the people, the places and the moments that Africa has been given to me, is something that I could never really do. And I think I never will, because it's impossible. Not that I don't like words - that's not the reason, at all. Words will stay forever. And I'm counting on it to make me remember all the wonderful days I've had here - someday later.

Everyday, you build your own story. You collect moments, meet people, live experiences that you can't "unlive" anymore. When it's done, it's done. No chance to press "repeat", "back" or "pause". A lot of times, you'll feel that time goes by quickly, it flies. Some people even say that life is short (...) for us, who live for so many years - complete nonsense!

All you need to do, is finding how to make the most of this life you have. If you manage to live life fully; if you find what moves you; if you are happy doing whatever you're doing: life is sooo much worth it. And as we can only live it once, we'd better make it a good one.

Now, even if you ask me a lot. Even if I put you in an empty house, no light, no water, no internet - with some charcoal to make food and a bucket of water to shower. Even if I seat you down on the floor while giving you some flour boiled in water to eat with your hands. Even if I made you live one of my days: I don'tthink you would ever quite understand.

Because I will never be able to make you feel what I feel everytime I see a baby breathe after a chaotic delivery. Everytime I lay down outside in the quiet, looking at the stars. Everytime I see a kid walking, when just the day before I was so afraid that he wouldn't wake up anymore. When I arrive to my village and the children run towards me, genuinely happy to see me.

Next time someone asks me "Why Africa?" my answer will be : because it makes me happy. That’s the most honest answer. And I'm pretty sure that if you could feel everything I feel - you would understand and it would make you happy too.

EN My day usually starts between 5 and 6 AM – at this time, I wake up and start my little morning routine. I light up the charcoal so I can boil water for my coffee, mix powder milk with water so I can eat my corn flakes and, in special occasions, eat a slice of bread with honey or Nutella (happiness in a jar).

Work at the hospital only starts at 07:30 AM, so I often have the time to do all the little things that I usually don’t have the time for: handwashing my clothes, writing back to the letters I’ve received, writing on my blog or journal, tidying my room – and everything else I keep cumulating in my to-do list.

When time comes, I go to the hospital – 50 meters from my house. In that day, I thought I had wake up inside a movie. I sit down in my usual chair, in the room where all the nurses and doctors from the hospital meet in the morning for the general handover. After hearing the handover from Paediatrics and General Ward, time comes for the Maternity nurse to start the report.

And this is where the movie begins:

Yesterday, at 9:00 PM we had a case of BBA– Born Before Arrival [and at this moment everybody sat really straight and paid attention to what was going to be said]. An expectant mother, in labour, came walking since her village, several miles from Mua, all by herself to deliver her baby. Problem: the baby came sooner than expected and this mother finally delivered alone, in the middle of nowhere, in the darkness with no help at all.After having the baby, the mother wrapped her in the pieces of fabric that were still clean – as mosto f them had now blood and soil on them. Then she put all of her belongings inside a big plastic bowl [the same where she had prepared everything that she needed to deliver in the hospital] and placed also the baby on it, still attached to the umbilical cord and to the placenta. After all this, this mother proceeded to put the plastic bowl in the top of her head and continue her walk, direction: the hospital. When the mother finally arrived to Mua Hospital, she sat down in a chair with the plastic thin in her lap and uncover the pieces of cloth that were protecting the baby.The baby is doing well. So is the mother.
I take a look around me, trying to read my colleagues’ reaction: even though they seem to be surprised, I can tell that isn’t new here. While I’m still trying to understand how, why, when and where this episode had taken place; it was time to start my shift in Maternity ward. I go to the big room where all the mothers sleep with their babies and it took me sometime to understand who the Super-Mom was. Because similar to all the other mothers, Super-Mom was sitting on her bed and holding Super-Baby on her arms. “This is the baby… the BBA”. And I couldn’t believe it. I couldn’t believe everything that happened to that mother, I couldn’t believe that she was alright hours after what must have been a little living hell. Maybe that mother doesn’t know: but she is one of the best Mothers in the whole World.

Once again, Life teaches me a lesson. Magic how our problems seem suddenly to be so small when everything is put in perspective. A few hours go by, and I’m still thinking about everything that happened. I go back to the Labour Room and see some bloody footprints on the floor.

For all of you who thought the movie was over – including me – it was not. Sit down and hold on tight because there is more to come.

“We have another BBA”, says the nurse. “This mother delivered her baby on the way”. I look to the mom, I look to the baby. The nurse starts to take care of the young mother really quickly: when cutting the umbilical cord after delivery, only the umbilical cord attached to the baby was clamped – using a tiny piece of fabric, as mothers are told on the antenatal clinic.

What this family didn’t know was that they also should have tightened the rest of the umbilical cord: still connected to the placenta, inside the mother’s uterus. And that explained all the blood on the floor… And all the rest she probably lost on her way to the hospital.

I focus my attention on the baby: cold from being wrapped in cloths wet from the blood and amniotic fluid, as well as dirty from the ground soil. The baby looks around him, to this crazy world where he just had arrived.

Quickly, I start cleaning the soil and pieces of dry herbs that were stuck to the baby’s head and body, wrap him in dry fabric and take him in my arms. “That was a hell of a first adventure, right little person?”

The mother stopped bleeding, finally – the nurse managed to remove the placenta. Some litres of IV fluids, blood transfusions and hours of rest after are enough to prove that these mothers are made of something special that I’ve never met before.

Why so many movies with Super-Heroes? If you only had one chance to meet all the amazing stories that happen in Malawi, you would feel like you’ve been teleptransported to another world. Here, everything is possible.